The effect of digital health interventions in older adults with frailty: a systematic review and meta-analysis

Frailty is prevalent among the elderly population and can lead to multiple negative health consequences.

This study compares the effects of digital interventions versus either non-digital interventions with the same content or routine treatment/care alone (or both) on improving physical function and frailty status in older adults, and clarifies the formal advantages and comprehensive benefits of digital interventions.

Systematic review and meta-analysis of randomized controlled trials.

Systematic searches of the PubMed, Embase, Web of Science, CINAHL, PsycINFO, the Cochrane Library, and CNKI for publications archived in the database between its launch and January 16, 2025. The meta-analysis was performed using stata 15.0 and 16.0. We used the 2019 Revised version of the Cochrane risk-of-bias tool (RoB 2.0) to evaluate the study's quality.

23 studies were conducted from 2007 to 2024 in 5 continents that investigated 3426 frail elderly participants were included in the review.The meta-analytic findings indicated superior efficacy in older adults with frailty for digital health interventions over control group on measures of the frailty scores (standardized mean difference (SMD)= -0.42, 95 % confidence intervals (CI) [-0.72, -0.12]; P = 0.006), grip strength (weighted mean difference (WMD)= 1.11, 95 % CI [0.09, 2.14]; P = 0.034), cognitive function (SMD= 0.12, 95 % CI [0.01, 0.24]; P = 0.038), and quality of life (SMD= 0.30, 95 % CI [0.11, 0.50]; P = 0.003). Subgroup analysis stratified by control group type revealed that the digital intervention combined with exercise group significantly improved frailty status (SMD= -0.52, 95 % CI[-0.96, -0.08]; P = 0.020), grip strength (WMD= 1.82, 95 % CI[0.53, 3.12]; P = 0.006), and cognitive function (SMD= 0.20, 95 % CI[0.04, 0.37]; P = 0.015) in elderly patients to a greater extent compared with the usual care group. There were no significant differences between digital health interventions and control groups on any of the remaining 5 comparisons: Timed Up and Go Test (WMD= -0.73, 95 % CI [-1.52, 0.06]; P = 0.07), gait speed (WMD= 0.02, 95 % CI [-0.05, 0.09]; P = 0.55), Short Physical Performance Battery (WMD = -0.17, 95 % CI [-1.14, 0.79]; P = 0.724), Sit-to-Stand Test (WMD = 0.19, 95 % CI [-0.69, 1.07]; P = 0.67), and depression (SMD = -0.21, 95 % CI [-0.47, 0.05]; P = 0.107). Meta-regression analyses revealed that covariates including sex distribution, country of origin, care setting, intervention type, intervention duration, and assessment methodology exhibited no significant moderating effects on grip strength, cognitive function, or quality of life outcomes.

The study results showed that frail elderly individuals who received digital health interventions improved their frailty status, grip strength, cognitive function, and quality of life. Furthermore, compared with the usual care group, the digital exercise intervention group showed superior effects on improving grip strength, frailty status, and cognitive function among frail elderly populations, suggesting that the "digital intervention combined with exercise" model should be prioritized for managing geriatric frailty in clinical practice. Future research should conduct more large-sample, homogeneous, high-quality clinical trials to more accurately verify the effects of core digital modules on frailty and physical function in the elderly.

CRD42024614928 (PROSPERO).